Does he like nurses, or are we part of his daily gripe?
I wondered about him as I softly scrubbed blood from the teeth of a man who had died moments before. From the chair where I quietly charted while he quietly ended, my patient’s sallow skin and sunken cheeks had looked so peaceful, but his garish dentition had saddened me.
Toothbrushing in dying seemed to contradict my orders to comfort, and my good sense. So I brushed afterwards, briefly. I brushed for the pride of this man I didn’t know, and for the family that I wished was present. The undertaker came to mind then, a new question I had never asked myself.
I finished, and he looked better (odd, death, better), with hair in place that I’d combed before turning things off, taking things away. He looked better, with the clean gown I’d given him before beginning his calculated exit, finishing his care. One can’t go with a stain on one’s left shoulder, I had reasoned.
I was strangely shocked at how shockingly strange it felt, to give end of life care in the total absence of any ceremony. With family and tradition missing, I was tasked only with the impersonal orders to stop the support of a human life – years and moments and memories to be completed in a few written steps. His wishes via his family were clear, but my patient’s unknown preferences and feelings, typically communicated by family members present in this process, seemed to create an oddly foreign vacuum in my care.
I could leave his hair a mess, his gown soiled – no one is here to request otherwise. Why does this seem so wrong?
I tentatively tried, felt need to create some tribute for my patient: Quiet, old New York jazz, a cracked window, the proxy-requested priest. A seeing of the setting sun. A double check of orders. How very odd it was – only me, a stranger, to enter life’s most intimate exit.
The jazz seemed presumptuous, I shut it off and stuck to my simple direction:
1640 Pre-extubation pain dose given per order.
1645 Extubated per order.
1650 Post-extubation pain dose given per order.
Some breaths but not many, some work but no pain.
1720 Asystole. Pronounced by MD.
Then, the unordered, the unprotocolized, the unspoken of care – who was this really for? The undertaker? The nurse? The respects? Toe tags and cloth straps, and plastic, most of it I find no use for. I pinch the artificial things to stop leaks, I leave a tiny pad below for what I can’t. Teeth, I guess, a bit improved.
Body, gown, tag, bag, zip, sticker, cover, done.
The lonely air of this death filled the empty room. I left the last move to my colleagues, and turned from my work just as the pink-yellow sky finished, and the navy night began.